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Stages, types and grades

Dukes' staging system

Doctors use different systems for staging bowel cancer. The most common system for bowel cancer is TNM staging.

About the Dukes' staging system

The Dukes' staging system is not really used anymore. But you might hear your doctor talking about your bowel cancer as Dukes’ A,B,C or D.

Find out about TNM staging

Dukes' A

The cancer is in the inner lining of the bowel. Or it is slightly growing into the muscle layer.  

Diagram showing Dukes' A bowel cancer.

Dukes' B

The cancer has grown through the muscle layer of the bowel. 

Diagram showing Dukes' B bowel cancer.

Dukes' C

The cancer has spread to at least 1 ​​ close to the bowel. 

Diagram showing Dukes' C bowel cancer.

Dukes' D

The cancer has spread to another part of the body, such as the liver, lungs or bones. 

In the number staging system, this is the same as stage 4. It is also called metastatic or advanced bowel cancer.

Diagram showing Dukes' D bowel cancer.

Treatment

The stage of your cancer helps your doctor to decide which treatment you need. Treatment also depends on:

  • your type of cancer (the type of cells the cancer started in)

  • where the cancer is in your bowel (colon or rectum)

  • other health conditions that you have

The stage of the cancer and these other factors can also give an idea of your outlook (prognosis).

The main treatments for cancer of the large bowel (colon cancer) are:

  • surgery

The main treatments for cancer of the back passage (rectal cancer) are:

  • surgery

  • chemotherapy

  • chemotherapy and radiotherapy together (​)

Read more about the treatment for bowel cancer that hasn’t spread

Metastatic cancer means your cancer has spread away from where it started. It is also called advanced cancer.

You might have chemotherapy or radiotherapy for bowel cancer that has spread. Sometimes you can also have surgery. This is to remove as much cancer as possible and help with your symptoms.

 You might also have:

•    a ​​   •    ​​ 

Read about bowel cancer that has spread

Other staging systems

Find out about the TNM staging Find out about the number stages

Last reviewed: 07 Nov 2024

Next review due: 07 Nov 2027

Stages and grades of bowel cancer

The stage of a cancer tells you how far it has grown through the bowel wall and whether it has spread to nearby lymph nodes or other organs. It helps your doctor to know which treatment you need.

TNM staging for bowel cancer

Tumour, node and metastasis (TNM) staging is one of the systems used to stage bowel (colon and rectal) cancer.

Treatment for bowel cancer

Treatment depends on whether you have colon or rectal cancer, as well as your cancer stage. You might have surgery, radiotherapy or chemotherapy or a combination of these.

Living with bowel cancer

Living with bowel (colorectal) cancer may mean you have changes to your diet, sex life or body image. There is support to help you cope.

Getting diagnosed with bowel cancer

You usually start by seeing your GP and they might refer you to a specialist and organise tests. Get information on what happens, and read about screening for bowel cancer.

Bowel (colorectal) cancer main page

Bowel cancer means cancer that starts in the colon (large bowel) or back passage (rectum). It is also known as colorectal cancer.

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